DLHS -2 DLHS-2 Himachal Pradesh Reproductive and Child Health District Level Household Survey 2002-04 International Institute for Government of India, Society for Applied Research in Ministry of Health & Humanities Population Sciences, Family Welfare, New Delhi – 110 067 (Deemed University) Mumbai – 400 088 New Delhi- 110 011 Reproductive and Child Health District Level Household Survey (DLHS -2) Himachal Pradesh 2002-04 International Institute for Ministry of Health & Society for Applied Research Population Sciences, Family Welfare, in Humanities (Deemed University) New Delhi- 110 011 New Delhi – 110 067 Mumbai – 400 088 CONTRIBUTORS Society for Applied Research in Humanities, New Delhi O. P. Vig Ummed Singh Ghanshyam Upadhyay B. K. Yadav Ajay Tripathi Ravikesh International Institute for Population Sciences, Mumbai F. Ram B. Paswan L. Ladu Singh K. C. Lakhara Akash Wankhede CONTENTS Page Tables …………………………………………………………………………….……… iv Figures …………………………………………………………………………..…..……vii Maps… …………………………………………………………………..……………….vii Preface and acknowledgement ……………………………………………………………ix Key Indicators …………………………………………………………………….………xi Salient Findings …………………………………………………………………..………xiii CHAPTER I INTRODUCTION 1.1 Background and Objectives of the Survey ………...……….………………………. 1 1.2 Survey Design..………………………….………..…………….…………………. 1 1.3 House Listing and Sample Selection …………….………….……….…………….2 1.4 Questionnaire ….……………………………….….………..…………….………..3 1.5 Fieldwork and Sample Coverage ……………..…………..………………………..4 1.6 Data processing ………………………………………..………………………….. 5 1.7 Sample Weights ………………………………..…………………………………..5 1.8 Sample Implementation ………………………..…………………………………..6 1.9 Basic Demographic Profile of the State…….………..………..……………………7 CHAPTER II BACKGROUND CHARACTERISTICS OF HOUSEHOLD 2.1 Age –Sex Structure.…………………………………………………………………9 2.2 Household Characteristic …………………………………………………………..10 2.3 Educational Level .…………………………………………………………………11 2.4 Marital Status of the Household Population ……………………………………….14 2.5 Marriages ……….………………………………………………………………….15 2.6 Morbidity Rates …..……………………………………………………………….. 16 2.7 Morbidity Rates by District……………………………………………………….. 18 2.8 Housing Characteristics ……………………………………………………………18 2.9 Housing Characteristics by District…………………………………………………21 2.10 Iodization of Salt ……………………………………………………………………22 2.11 Iodization of Salt by District……………… .………………………………………23 2.12 Availability of Facilities and Services in Rural Population…………………………24 2.13 Availability of Education Facility and Health Services by District…………………26 CHAPTER III CHARACTRERISTICS OF WOMEN, HUSBANDS AND FERTILITY 3.1 Background Characteristics of Women ……………………………………………31 3.2 Educational Level of Women ………………………………………………………33 3.3 Background Characteristics of Husbands’ of Eligible Women ……………………34 3.4 Educational Level of Husbands’ of Eligible Women ………………………………36 3.5 Children Ever Born and Surviving …………………………………………………37 3.6 Completed Fertility by District……………. ………………………………………38 3.7 Birth Order …………………………………………………………………………39 3.8 Birth Order by District ……………………………………………………………..40 3.9 Fertility Preference …………………………………………………………………41 3.10 Pregnancy Outcomes ………………………………………………………………42 Page CHAPTER IV MATERNAL HEALTH CARE 4.1 Antenatal Check-Ups…………………………………………………………………45 4.2 Antenatal Check-Ups at Health Facility……………………..………………………48 4.3 Antenatal Check-Ups by District…………………………….………………………50 4.4 Components of Antenatal Check-Ups………………………………………….……51 4.5 Antenatal Care Services………………………………………………………..…… 51 4.6 Antenatal Care Indicator by Districts…………………………………………..……56 4.7 Pregnancy Complication and Treatment………………………………………..……58 4.8 Delivery Care……………………………………………………………………...…61 4.8.1 Place of Delivery………………………………………………………………….…61 4.8.2 Assistance during Home Delivery ………………………………………………..…64 4.8.3 Delivery Assisted by Skilled Person…………………..…………………………..…64 4.9 Reasons for Not Going to Health Institutions for Delivery……………………….…66 4.10 Delivery Characteristics by Districts………………………………………………...67 4.11 Complication during Delivery….……….…………………………………………...68 4.12 Post Delivery Complication and Treatment …………………………………..……. 70 4.13 Obstetric Morbidity by District …….……..…………………………………………73 CHAPTER V CHILD CARE AND IMMUNIZATION 5.1 Breastfeeding……………………………….……………..…………………………77 5.1.1 Breastfeeding by Districts……………………………………………………………79 5.2 Immunization of Children……………………………………………………………81 5.3 Source of Immunization………………………………………………………………85 5.4 Vitamin A and IFA Supplements …….. ……………………….……………………86 5.5 Immunization Coverage by Districts…………………………………………………88 5.6 Child Morbidity and Treatment………………………………………………………89 5.6.1 Awareness of Diarrhoea…………………….………………………………………89 5.6.2 Treatment of Diarrhoea………………………………………………………………89 5.6.3 Awareness of Pneumonia …………………….………………………………………91 5.6.4 Treatment of Pneumonia……………………………………………………………92 5.6.5 Knowledge of Diarrhoea Management and Pneumonia by District. …….…………94 CHAPTER VI FAMILY PLANNING 6.1 Knowledge of Family Planning Methods…….………………………………………97 6.1.1 Knowledge of Family Planning Methods by District……..…………………………98 6.1.2 Knowledge of No-Scalpel Vasectomy ….……………..……………………………100 6.1.3 Knowledge of No-Scalpel Vasectomy by District………..…………………………100 6.2 Current Use of Family Planning Methods….……………..…………………………101 6.2.1 Current Use of Family Planning Methods by District……..…………………………103 6.2.2 Current Use and Ever Use of Family Planning Methods by Women.………………104 6.2.3 Current Use and Ever Use of Family Planning Methods as Reported by Husbands. 104 6.3 Reasons for Not Using Male Methods.…….……………..…………………………106 6.4 Source of Contraceptive Methods………….……………..…………………………106 ii Page 6.5 Problems with Current Use of Contraceptive Method……..……………………… 108 6.6 Treatment for Health Problems with Current Use of Contraception……….....……109 6.7 Advice to Non-Users to Use Contraception…………..………………………….…109 6.7.1 Future Intension to Use Contraceptive ….……………..……………………………110 6.7.2 Future Intention to Use Among Women by Number of Living Children……………112 6.8 Reasons for Discontinuation and Non-Use of Contraception………………………112 6.8.1 Reasons for Not Using Contraceptive Methods…………..…………………………113 6.9 Unmet Need for Family Planning Services..……………..…………………………115 6.9.1 Unmet Need for Family Planning Services by District…..…………………………115 CHAPTER VII ACCESSIBILITY AND PERCEPTION ABOUT GOVERNMENT HEALTH FACILITIES 7.1 Home Visit By Health Worker………………………..…………………………… 119 7.2 Home Visit By Health Worker by District..……………..………………………… 121 7.3 Matter Discussed during Home Visit or Visits to Health Facilities.…………………122 7.4 Visit to Health Facility………………….……………..……………………………124 7.5 Visit to Health Facility by District…………….……..………………………………125 7.6 Client’s Perception of Quality of Government Health Services.……………………125 7.7 Reasons for Not Visiting Government Health Centre….……………………..…… 126 7.8 Family Planning Information and Advice Received ………….……………………126 7.9 Availability of Pills and Condom………..…………..…………………………..… 127 7.10 Quality of Care of Family Planning Services……………..…………………………127 7.11 Quality of Care Indicators for Contraceptive Users by District. ……………………129 7.12 Quality of Care of Maternal Health Care….……………..…………………………130 CHAPTER VIII REPRODUCTIVE HEALTH PROBLEMS AND AWARENESS OF RTIs/STIs and HIV/AIDS 8.1 Awareness of RTI/STI……………………………………………………………….133 8.1.1 Knowledge of Mode of Transmission of RTI/STI……………………………………135 8.2 Prevalence of RTI/STI……………….. ………………………………………………138 8.3 Menstruation Related Problems………………………………………………………142 8.4 Prevalence of RTI/STI by District …….. ……………………………………………143 8.5 HIV/AIDS……………………………………………………………………………144 8.5.1 Knowledge of HIV/AIDS……………………………………………………………145 8.5.2 Knowledge of Mode of Transmission about HIV/AIDS…………………………….148 8.5.3 How to avoid HIV/AIDS…………………………………………………………….150 8.5.4 Misconception about HIV/AIDS…………………………………………………….153 8.5.5 Knowledge of Curability of HIV/AIDS………………………………………………155 8.6 Awareness of RTI/STI and HIV/AIDS by District…………….…………………… 155 APPENDICES Appendix A Estimation of Sampling Errors ……………………….…..………….… 157 Appendix B DLHS Staff …………………………………………………………..…163 Appendix C Questionnaire ……………………………………………………..…… 167 iii TABLES Page Table 1.1 Number of households interviewed..…………………………..……………. 7 Table 1.2 Number of women and husbands interviewed ……………………..…..……7 Table 1.3 Basic demographic indicator ……………………………………………..… 8 Table 2.1 Household population by age and sex …………………………………..……10 Table 2.2 Household characteristics ………………………….……………………..…11 Table 2.3 Educational level of the household population …………………………..…12 Table 2.4 Marital status of the household population ……………………………..……15 Table 2.5 Marriage ……………………………………………………………..………16 Table 2.6 Morbidity rates ……………………….…………………………………..…17 Table 2.7 Morbidity rates by district……… …………………………………..………18 Table 2.8 Housing characteristics …………………………………………………..… 19 Table 2.9 Housing characteristics by district……….. ………………………..……….21 Table 2.10 Iodization of salt…………………………………………………………..…23 Table 2.11 Iodization of salt by district……… ………………………………..………. 24 Table 2.12 Distance from the nearest education facility …………………………..……25 Table 2.13 Distance from the nearest health facility ………………………………..……25 Table 2.14 Availability of services …………………………………………………..… 26 Table 2.15 Availability of facility and services by district…………. …………..………26 Table 3.1 Background characteristics of women …………………………………..……32 Table 3.2 Level of education of eligible women …………………………………..……34 Table 3.3 Background characteristics of men ……………………………………..……35 Table 3.4 Level of education